6.4: Coping with and Managing Stress

Coping with and Managing Stress

Stress is an inevitable part of life, but the way we perceive and respond to it determines its impact on our health and well-being. Effective stress management involves understanding our unique reactions to stressors and employing strategies that help us regain control and resilience. This section explores the cognitive processes behind stress perception, outlines various coping mechanisms, and offers practical techniques to manage stress. By developing adaptive coping skills and incorporating healthy habits, we can mitigate the harmful effects of stress and enhance our overall quality of life.

Lazarus’s Theory of Cognitive Appraisal

The process by which we experience a situation is described by Lazarus’s Theory of Cognitive Appraisal. This theory may be beneficial to our understanding of the differences between individual’s stress levels. The theory’s main points are:

1. When we experience a situation or event we first determine if it is a threat, a challenge, or is neutral.
2. We then assess our inventory of resources to cope with the event. If we do not perceive we are adequate to the task, we must be able to withdraw or we will feel trapped in a situation with aversive consequences coming. That induces distress and all the physiological processes that harm our health. If we perceive that we have the resources to successfully cope with the situation, we feel challenged and optimistic. Note that challenge and optimism are related to enhanced health and sense of well-being.

This second stage of appraisal impacts the first stage in a loop process. If we at first perceive a threat but then realize we can handle it, it reduces the distress and may even create a perception of challenge. If at first we perceive a challenge but then realize that we don’t have what it takes to be successful, we may begin to experience distress as we see the aversive outcome of failure looming ahead. Depending on the meaning of the outcome to us, the distress may be mild or severe. 

Coping  

There are two main types of coping:

• Instrumental coping: solves the problem and removes the stressor from our experience (e.g., resolving a conflict or improving financial stability).
• Palliative coping: alters our physiological reactions to stress that will not go away and cannot be escaped. (e.g., relaxation techniques, reinterpreting the stressor, or adopting an optimistic outlook).

As we go to our repertoire of coping skills to select one or more, we may become more optimistic about success and reappraise the situation in the first step. It may become less threatening and hence less distressful. We could find that our coping resources will be less adequate than we initially thought and we would become more threatened now. This interactive appraisal and coping process is at the heart of the impact of stress on us. If we interpret a situation as stressful, it has a stress-related effect on us. If we have few coping sources, more situations will be perceived as distressing. If we have many coping resources, more situations will be perceived as challenging or at least neutral.

For example, I notice my car has a flat tire. I could be annoyed at the trouble it causes or feel threatened by past negative experiences associated with changing a tire. If I don’t know how to change a tire and it is dark out, I may feel very threatened as I perceive helplessness and vulnerability. If I assure myself I am safe, and I do know how to change a tire, I may decide that I will get this done in ten minutes and be on the road safely. Or If I do not have the skills to change a tire but have a cell phone I can call a close friend who will quickly lend a hand. This example outlines the appraisal and coping process. Perception is critically important. If I have little confidence in myself to handle a flat tire even though I have been taught how to do it and have the tire, I may feel more threatened. If I have the cell phone but don’t believe I should bother anybody to come here, or don’t believe they would want to help me, the distress levels will increase. The facts themselves do not cause the stress—your perception of those facts does.

Different people perceive the same event in different ways. Past experiences, learned skills, personality traits, current stress levels, and optimism all shape how we appraise situations. Social support is a powerful resource that can ease distress. Simply having someone who listens, offers encouragement, and shares experiences can significantly improve one’s ability to cope.

Managing Stress

Everyone must deal with stress. Some steps can be taken to help positively manage stress and keep it from increasing the risk of illness. Try these tips to keep stress in check:

Develop a new attitude

• Become a problem solver. Make a list of the things that cause stress. From your list, figure out which problems you can solve now and which are beyond your control for the moment. From your list of problems that you can solve now, start with the little ones. Learn how to calmly look at a problem, think of possible solutions, and take action to solve the problem. Being able to solve small problems will give you the confidence to tackle the big ones. Feeling confident that you can solve problems will go a long way to helping you feel less stressed.
• Be flexible. Sometimes, it’s not worth the stress to argue. Give in once in a while or meet people halfway.
• Get organized. Think ahead about how you’re going to spend your time. Write a to-do list. Figure out what’s most important to do and do those things first.
• Set limits. When it comes to things like work and family, figure out what you can really do. There are only so many hours in the day. Set limits for yourself and others. Don’t be afraid to say NO to requests for your time and energy.

Relax

• Take deep breaths. If you’re feeling stressed, taking a few deep breaths lowers your heart rate and helps your muscles relax.
• Stretch and massage. Stretching and massaging your muscles can also help you relax and feel less tense. 
• Take time for yourself. We all have lots of things that we have to do. But often we don’t take the time to do the things that we want to do. It could be listening to music, reading a good book, or going to a movie. You should not feel guilty for having a little "me" time!

Take care of your body

• Get enough sleep. Getting enough sleep helps you recover from the stresses of the day. Also, being well-rested helps you think better so that you are prepared to handle problems as they come up. Most adults need 7 to 9 hours of sleep a night to feel rested.
• Eat right. Try to fuel up with fruits, vegetables, beans, and whole grains. Don’t be fooled by the jolt you get from caffeine or high-sugar snack foods. Your energy will wear off, and you could wind up feeling more tired than you did before.
• Get moving. Getting physical activity not only helps relax your tense muscles but improves your mood. Research shows that physical activity can help relieve symptoms of depression and anxiety.
• Don’t deal with stress in unhealthy ways. This includes drinking too much alcohol, using drugs, smoking, or overeating.

Connect with others

• Share your stress. Talking about your problems with friends or family members can sometimes help you feel better. They might also help you see your problems in a new way and they may suggest solutions that you hadn’t thought of.
• Get help from a professional if you need it. If you feel that you can no longer cope, talk to your doctor. She or he may suggest counseling to help you learn better ways to deal with stress. Your doctor may also prescribe medicines, such as antidepressants or sleep aids.
• Help others. Volunteering in your community can help you make new friends and feel better about yourself.

Coping with Stress

The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:

• Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
• Get proper health care for existing or new health problems.
• Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
• Recognize signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Set priorities-decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
• Note what you have accomplished at the end of the day, not what you have been unable to do.
• Avoid dwelling on problems. If you can’t do this on your own, seek help from a qualified mental health professional who can guide you.
• Schedule regular times for healthy and relaxing activities.
• Explore stress-coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.
• Exercise regularly – just 30 minutes per day of gentle walking can help boost mood and reduce stress.

Exercise 

There is also a psychophysiological framework for explaining how exercise not only reduces the immediate effects of stress but also enhances the recovery from stressors. This framework is called the Physiological Toughness Model and it theorizes that intermittent but regular exposure to stressors, like exercise, can lead to psychological coping, emotional stability, and physiological changes. These physiological changes include increases in endorphins and reductions in stress hormones which lead to:

• Improvements in performance during challenging/threatening situations
• Better immune system functioning
• Improved stress tolerance. 

Furthermore, engaging in challenging yet manageable activities (e.g. distance running, downhill skiing, mountain biking, and rock climbing) promotes focus, satisfaction, and well-being. These activities have been described by Csikszentmihalyi as the experience of “flow” or the "flow state". These activities capture attention, making them very easy to continue, and very hard to stop. Many other activities, such as art and playing musical instruments, produce “flow”, but the essence of the experience is to be on the edge of challenge and failure with the perception that your efforts will make the difference between good and bad outcomes. In these conditions stress builds healthier bodies and higher well-being. People who experience “flow” frequently report high degrees of satisfaction in life.

Meditation

The term meditation refers to a group of techniques that may be practiced for many reasons, such as to increase calmness and physical relaxation, to improve psychological balance, to cope with illness, or to enhance overall wellness. Most types of meditation have four elements in common:

• A quiet location. Meditation is usually practiced in a quiet place with as few distractions as possible. This can be particularly helpful for beginners.
• A specific, comfortable posture. Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions.
• A focus of attention. Focusing one’s attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath.
• Having an open attitude. During meditation, this means letting distractions come and go naturally without judging them.

It is not fully known what changes occur in the body during meditation; whether they influence health; and, if so, how. The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on complementary and alternative medicine (CAM) including research on meditation. There is evidence that mediation can reduce stress in caregivers for elderly patients with dementia, relieve asthma symptoms, lower blood pressure in individuals with hypertension, and reduce arthritis pain.

Relaxation Techniques

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.
Relaxation techniques (also called relaxation response techniques) may be used by some to release tension and to counteract the ill effects of stress. Relaxation techniques are also used to induce sleep, reduce pain, and calm emotions. 

Relaxation is more than a state of mind; it physically changes the way your body functions. When your body is relaxed breathing slows, blood pressure and oxygen consumption decrease, and some people report an increased sense of well-being. This is called the “relaxation response.” Being able to produce the relaxation response using relaxation techniques may counteract the effects of long-term stress, which may contribute to or worsen a range of health problems including depression, digestive disorders, headaches, high blood pressure, and insomnia.

Relaxation techniques often combine breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Most relaxation techniques can be self-taught and self-administered, others require only brief instruction from a book or experienced practitioner before they can be done without assistance. These techniques may be most effective when practiced regularly and combined with good nutrition, regular exercise, and a strong social support system.

Some relaxation response techniques include:

• Autogenic training: When using this method, you focus on the physical sensation of your own breathing or heartbeat and picture your body as warm, heavy, and/or relaxed.
• Biofeedback: Biofeedback-assisted relaxation uses electronic devices to teach you how to consciously produce the relaxation response. Biofeedback is sometimes used to relieve conditions that are caused or worsened by stress.
• Deep breathing or breathing exercises: To relax using this method, you consciously slow your breathing and focus on taking regular and deep breaths.
• Guided imagery: For this technique, you focus on pleasant images to replace negative or stressful feelings and relax. Guided imagery may be directed by you or a practitioner through storytelling or descriptions designed to suggest mental images (also called visualization).
• Progressive relaxation: (also called Jacobson’s progressive relaxation or progressive muscle relaxation). For this relaxation method, you focus on tightening and relaxing each muscle group. Progressive relaxation is often combined with guided imagery and breathing exercises.
• Self-Hypnosis: In self-hypnosis, you produce the relaxation response with a phrase or nonverbal cue (called a “suggestion”). Self-hypnosis may be used to relieve pain (tension headaches, labor, or minor surgery) as well as to treat anxiety and irritable bowel syndrome.

If you are thinking about using relaxation techniques for health:

• Do not use relaxation techniques as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• Ask about the training and experience of the practitioner or instructor you are considering for any complementary alternative medicine practice.
• Look for published research studies on relaxation for the health condition in which you are interested. Remember that some claims for using relaxation therapies may exceed the available scientific evidence.
• Tell all your healthcare providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Resilience

Resilience refers to the ability of an individual, family, organization, or community to cope with adversity and adapt to challenges or change. It is an ongoing process that requires time and effort and engages people in taking several steps to enhance their response to adverse circumstances. Resilience implies that after an event, a person or community may not only be able to cope and recover but also change to reflect different priorities arising from the experience and prepare for the next stressful situation.

Resilience is the most important defense people have against stress. Resilience will enable the development of a reservoir of internal resources to draw upon during stressful situations. Resilience changes over time. It fluctuates depending on how much a person nurtures internal resources or coping strategies. Some people are more resilient in work life, while others exhibit more resilience in their relationships. It is not a trait that people either have or do not have, it can be learned and developed in anyone. Some ways to build resilience include:

• Making connections with others
• Looking for opportunities for self-discovery
• Nurturing a positive view of self
• Accepting that change is a part of living
• Taking decisive actions
• Learning from the past

The ability to be flexible is a great skill to obtain and facilitates resilience growth. Getting help when it is needed is crucial to building resilience. An approach to building resilience that works for one person might not work for another. People use varying strategies. Resilience involves maintaining flexibility and balance in life during stressful circumstances and traumatic events. Being resilient does not mean that a person does not experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Stress can be dealt with proactively by building resilience to prepare for stressful circumstances while learning how to recognize symptoms of stress. Fostering resilience or the ability to bounce back from a stressful situation is a proactive mechanism for managing stress.